Hand Fellowship Applicants

[maxheadroom]

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I don't know if there are any other Hand Fellowship applicants on SDN these days, but if you're out there, drop a word. I'm finally starting to hear from programs and I'd like to start a little discussion on what people know about the different programs.

 

[Castro Viejo]

Not an applicant, but I hear Louisville is supposed to be the shiznat for Hand.

Is Hand that much more desirable for an aspiring PRS than Burn?

 

[gasnewby]

for some reason it seems to be (hand > burn)

louisville is doing hand transplants, they're a pretty big deal.

 

[Castro Viejo]

Hmmm... I always figured that an aspiring PRS would want to publish a lot and that there's more to be published in Burns. Then there's the "What if I never match to PRS?" question.

Hell, if I didn't match to PRS and all I had was my General Surgery training and Hand, I'd be an out of work Hand Surgeon lapping bellys. But with Burns, I can run Burn Units and stuff like that and do some skin grafts.

I dunno. I guess this is why I decided on Vascular Surgery.

 

[maxheadroom]

I'm actually an integrated plastics resident now. I'm one of those few people who actually wants to do hand surgery.

 

[maxheadroom]

Oh, and hand transplants are one of the stupidest things I've ever seen. They get almost no intrinsic function and barely achieve protective sensation. At least one of the handful of U.S. hand transplant patients has had his removed because of the poor function and morbidity of the immunosuppression regimen.

Just look at the photos of the French woman with the face transplant. The transplant looks good, but the rest of her face looks terrible after a year of immunosuppression. Plus, she's in renal failure. Maybe hand/face transplants will become a real tool when Composite Tissue Allotransplantation guys finds a better method for dealing with rejection, but until then it's a bad idea. Just my 2 cents, though.

 

[Pir8DeacDoc]

seems very marketable, at least in academics to have done a hand fellowship. Plus, when you get old you can just do carpal tunnel releases and still make good money without working long hours.

 

[SLUser11]

seems very marketable, at least in academics to have done a hand fellowship. Plus, when you get old you can just do carpal tunnel releases and still make good money without working long hours.

I don't know for sure, but from what I remember from med school, Plastics trained surgeons don't HAVE to complete a hand fellowship to have hospital privileges. Hand and burn are both integrated into their training. However, the ortho guys DO have to do a hand fellowship.

This is all word of mouth from Plastics and Ortho physicians that I worked with in med school. However, it's been reinforced by the practicing physicians here in Wichita.

Of course, sexy Hollywood procedures like hand transplant may require some extra training....

 

[Castro Viejo]

I don't doubt a PRS or Orthopod who trained additionally in Hand would be uber marketable. I'm pretty sure they would be.

I'm talking about a General Surgeon, one who aspired to be a PRS but got sidetracked and never made it out of Hand... What about him? Can you find work as a Hand only surgeon WITHOUT PRS or Ortho under your belt at all?

I'd guess no, since there are PRS and Orthopods out there who can do Hand without fellowship training. So as a backdoor to PRS, I would think, Hand is a terrible idea for a General Surgeon who never found a willing PRS residency.

Burns, on the other hand, seems like it'd be a better deal. Burns still pays well for the Burn Surgeon and the institution that cares for the Crispy Critters. So I would guess that there's plenty of work to go around. Of course there are PRS guys who cover Burns, but I doubt they play with much of the critical care aspect. You'd be an all around, one-stop shop -- a Crispy Surgeon, if you will. You can take care of the drips, fluid management, skin grafts, tub washes, etc...

And then there's the research aspect, no? To beef up one's application for another go at PRS? I'd guess that there's much more publishable data as a Burns fellow than a Hand fellow. That's just my guess without knowing much of either specialty's literature.

 

[maxheadroom]

Several things:

1. Most plastic surgeons probably don't need hand fellowship to do most hand cases, but that depends upon how much exposure they get in residency. At my place we have numbers way above most hand fellowships for most things. I'm doing the fellowship to be CAQ eligible and to get experience in a few things that we don't do as much in (brachial plexus, congenital, complex wrist stuff).

2. Most orthopods can do most hand surgery without a fellowship, either. Again, depends upon their exposure in residency.

3. Compensation for Burns is highly dependent upon your patient population. If you're getting lots of meth lab burns, you aren't getting paid. There are fewer and fewer industrial burns due to better safety systems.

4. There is tons of research in Hand surgery, especially in clinical outcomes.

 

[gasnewby]

I don't know for sure, but from what I remember from med school, Plastics trained surgeons don't HAVE to complete a hand fellowship to have hospital privileges. Hand and burn are both integrated into their training. However, the ortho guys DO have to do a hand fellowship.

that's interesting. i wonder what kind of #s the ortho guys get. they alternate hand call with plastics at my house, so i'm sure they get a bunch.

 

[gasnewby]

Compensation for Burns is highly dependent upon your patient population. If you're getting lots of meth lab burns, you aren't getting paid. There are fewer and fewer industrial burns due to better safety systems.

that could be true. i'm going to make the argument that burn docs are salaried and usually work in burn centers. however, some burn centers are run by a for-profit practice. i know at least one.

 

[maxheadroom]

I'm only familiar with three burn centers. At two of them, I know that the surgeons have been voicing concern about their bottom line because of an increase in no-pay patients. While there might be some salary support from hospitals, most surgeons get paid for working. When the patient is uninsured, you work for free.

 

[droliver]

Burn unit profitability is dependent on the industrial burns' worker's comp system to remain in the black (as Max noted). Units without this kind of payor mix have a hard time making ends meet.

I'd disagree with the notion that a general surgeon couldn't make it as a hand surgeon. There is a tremendous market for hand surgeons (of whatever stripe) because Plastic Surgeons have abandoned it en masse and most orthopedists are also moving in that direction. ER coverage for hand injury is non-existant in an increasing # of hospitals, even in large metro areas.

 

[JosephFaecesMD]

Burn unit profitability is dependent on the industrial burns' worker's comp system to remain in the black (as Max noted). Units without this kind of payor mix have a hard time making ends meet.

I'd disagree with the notion that a general surgeon couldn't make it as a hand surgeon. There is a tremendous market for hand surgeons (of whatever stripe) because Plastic Surgeons have abandoned it en masse and most orthopedists are also moving in that direction. ER coverage for hand injury is non-existant in an increasing # of hospitals, even in large metro areas.

My cousin did general surgery residency with someone who went into hand. It was hell for her to find a fellowship that would take her (I think she had to do a year of pro-bono research - maybe she wanted to stay at a particular program - ?) Then, when she got out she could not find a job in the area she wanted. Ended up joining a general surgery practice for a while, I think. She told me that if I wanted to do hand, better do plastics or ortho as it leaves your options open and makes finding a better job possible.

 

[Castro Viejo]

My cousin did general surgery residency with someone who went into hand. It was hell for her to find a fellowship that would take her (I think she had to do a year of pro-bono research - maybe she wanted to stay at a particular program - ?) Then, when she got out she could not find a job in the area she wanted. Ended up joining a general surgery practice for a while, I think. She told me that if I wanted to do hand, better do plastics or ortho as it leaves your options open and makes finding a better job possible.

That's kind of what I thought.

But Dr. Oliver's sentiments seem to indicate that Hand-trained General Surgeons can do quite well. That's great news for those who may never make it passed the 50% rate in the PRS match. 🙂

 

[Pir8DeacDoc]

I've heard it's hard for a hand surgeon trained via GS to make it as they can only take hand call. A plastics group would much prefer someone who can take hand and face call. Plus, while you're building a practice what sort of bread and butter would you do, lap choles or hernias? Would you take GS call too?


I'm sure this could work out, I've just heard it can be a real obstacle.